Sedation Challenges: Obesity and Sleep Apnea

Abstract

This article reviews the data for diagnostic and uncomplicated therapeutic upper endoscopy, which show it is safe and effective to perform the procedure under moderate sedation with a combination of benzodiazepine and opioids. For more complex procedures or for superobese patients anesthesia support is recommended. Performing endoscopy in this population should alert providers to plan carefully and individualize sedation plans because there is no objective way to quantify this risk pre-endoscopically.

Keywords: Anesthesia; Bariatric endoscopy; Colonoscopy; Endoscopy; Gastric bypass; Obesity; Sedation.

Copyright © 2016 Elsevier Inc. All rights reserved.

Figures

Figure 1

Original Mallampati Score. 1A: Mallampati class 1. Faucial pillars, soft palate and uvula are visible. 1B: Mallampati class 3. Only soft palate is visible. Taken from Mallampati S, Gatt SP, Gugino LD, et al. A clinical sign to predict difficult tracheal intubation: a prospective study. Can Aneasth Soc J 1985;32:429–34.

Figure 1

Original Mallampati Score. 1A: Mallampati class 1. Faucial pillars, soft palate and uvula are visible. 1B: Mallampati class 3. Only soft palate is visible. Taken from Mallampati S, Gatt SP, Gugino LD, et al. A clinical sign to predict difficult tracheal intubation: a prospective study. Can Aneasth Soc J 1985;32:429–34.

Figure 2

Modified Mallampati score. Used with permission from Samsoon GL, Young JR. Difficult tracheal intubation. Anaesthesia 1987;42:487–90.